Abstract
This study investigated the clinical long-term effect of incobotulinumtoxinA (incoBoNT/A) in 33 cervical dystonia (CD) patients who had developed partial secondary therapy failure (PSTF) under previous long-term botulinum toxin (BoNT) treatment. Patients were treated four times every 12 weeks with incoBoNT/A injections. Physicians assessed treatment efficacy using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) at the baseline visit, week 12 and 48. Patients rated quality of life of CD with the Craniocervical Dystonia Questionnaire (CDQ-24). Titres of neutralizing antibodies(NAB) were determined at start of the study and after 48 weeks. All patients had experienced significant and progressive worsening of symptoms in the last 6 months of previous BoNT treatment. Repeated incoBoNT/A injections resulted in a significant reduction in mean TWSTRS at week 12 and 48. Patients' rating of quality of life was highly correlated with TWSTRS but did not change significantly over 48 weeks. During the 48 weeks -period of incoBoNT/A treatment NAB titres decreased in 32.2%, did not change in 45.2%, and only increased in 22.6% of the patients. Thus, repeated treatment with the low dose of 200 MU incoBoNT/A over 48 weeks provided a beneficial clinical long-term effect in PSTF and did not booster titres of NAB.
Highlights
Intramuscular injections of botulinum neurotoxin (BoNT) have become the treatment of choice for patients with cervical dystonia (CD) [1, 2]
Repeated botulinum toxin (BoNT) injection therapy can lead to reduced responsiveness to treatment [partial secondary treatment failure (PSTF)] and to the development of neutralizing antibodies (NABs) against botulinum neurotoxin
Thirty-three CD patients (17 females/16 males; mean age 56.4 ± 5.2 years) under long-term BoNT treatment presenting with partial secondary therapy failure were included in the study
Summary
Intramuscular injections of botulinum neurotoxin (BoNT) have become the treatment of choice for patients with cervical dystonia (CD) [1, 2]. BoNT preparations are high molecular weight aggregates of the biologically active neurotoxin (a polypeptide with a 100 kDa heavy chain and a 50 kDa light chain) and complexing proteins (hemagglutinating and non-hemagglutinating) [3, 4]. Repeated BoNT injection therapy can lead to reduced responsiveness to treatment [partial secondary treatment failure (PSTF)] and to the development of neutralizing antibodies (NABs) against botulinum neurotoxin. Neutralizing antibodies had been detected in more than 17% of CD patients following onaBoNT/A treatment [9,10,11] before the protein content in this preparation was altered in 1998. Following the reduction of protein content, NABs were only reported in 1.2% of the patients receiving onaBoNT/A [12]. In more recent cross-sectional studies prevalence of NABs was found to be even larger than 10% in patients being long-term treated over more than 10 years [14, 15]
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